Provider Demographics
NPI:1609457332
Name:DUBOIS-HORNSBY, LATRINA (APN)
Entity Type:Individual
Prefix:
First Name:LATRINA
Middle Name:
Last Name:DUBOIS-HORNSBY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 BIRCH PL UPPR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3002
Mailing Address - Country:US
Mailing Address - Phone:716-897-1184
Mailing Address - Fax:
Practice Address - Street 1:40 BIRCH PL UPPR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3002
Practice Address - Country:US
Practice Address - Phone:716-897-1184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310157363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty